 An electron micrograph of rotavirus, the cause of nearly 40% of hospitalizations from diarrhea in children under 5.[1] |
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| ICD-10 | A09., K59.1 |
|---|---|
| ICD-9 | 787.91 |
| DiseasesDB | 3742 |
| eMedicine | ped/583 |
| MeSH | D003967 |
Diarrhea (from the Greek, διὰρροια meaning "a flowing through"[2]), also spelled diarrhoea, is the condition of having three or more loose or liquid bowel movements per day.[3] It is a common cause of death in developing countries and the second most common cause of infant deaths worldwide. The loss of fluids through diarrhea can cause dehydration and electrolyte imbalances. In 2009 diarrhea was estimated to have caused 1.1 million deaths in people aged 5 and over[4] and 1.5 million deaths in children under the age of 5.[1] Oral rehydration salts and zinc tablets are the treatment of choice and have been estimated to have saved 50 million children in the past 25 years.[1]
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Diarrhea is defined by the World Health Organization as having 3 or more loose or liquid stools per day or as having more stools than is normal for that person.[3]
Secretory diarrhea means that there is an increase in the active secretion, or there is an inhibition of absorption. There is little to no structural damage. The most common cause of this type of diarrhea is a cholera toxin that stimulates the secretion of anions, especially chloride ions. Therefore, to maintain a charge balance in the lumen, sodium is carried with it, along with water. In this type of diarrhea intestinal fluid secretion is isotonic with plasma even during fasting .[5]
Osmotic diarrhea occurs when too much water is drawn into the bowels. This can be the result of maldigestion (e.g., pancreatic disease or Coeliac disease), in which the nutrients are left in the lumen to pull in water. Osmotic diarrhea can also be caused by osmotic laxatives (which work to alleviate constipation by drawing water into the bowels). In healthy individuals, too much magnesium or vitamin C or undigested lactose can produce osmotic diarrhea and distention of the bowel. A person who has lactose intolerance can have difficulty absorbing lactose after an extraordinarily high intake of dairy products. In persons who have fructose malabsorption, excess fructose intake can also cause diarrhea. High-fructose foods that also have a high glucose content are more absorbable and less likely to cause diarrhea. Sugar alcohols such as sorbitol (often found in sugar-free foods) are difficult for the body to absorb and, in large amounts, may lead to osmotic diarrhea.[5]
Exudative diarrhea occurs with the presence of blood and pus in the stool. This occurs with inflammatory bowel diseases, such as Crohn's disease or ulcerative colitis, and other severe infections.[5]
Motility-related diarrhea is caused by the rapid movement of food through the intestines (hypermotility). If the food moves too quickly through the GI tract, there is not enough time for sufficient nutrients and water to be absorbed. This can be due to a vagotomy or diabetic neuropathy, or a complication of menstruation[citation needed]. Hyperthyroidism can produce hypermotility and lead to pseudodiarrhea and occasionally real diarrhea. Diarrhea can be treated with antimotility agents (such as loperamide). Hypermotility can be observed in patients who have had portions of their bowel removed, allowing less total time for absorption of nutrients.
Inflammatory diarrhea occurs when there is damage to the mucosal lining or brush border, which leads to a passive loss of protein-rich fluids, and a decreased ability to absorb these lost fluids. Features of all three of the other types of diarrhea can be found in this type of diarrhea. It can be caused by bacterial infections, viral infections, parasitic infections, or autoimmune problems such as inflammatory bowel diseases. It can also be caused by tuberculosis, colon cancer, and enteritis.[citation needed]
Generally, if there is blood visible in the stools, it is not diarrhea, but dysentery. The blood is trace of an invasion of bowel tissue. Dysentery is a symptom of, among others, Shigella, Entamoeba histolytica, and Salmonella.
Diarrhea is most commonly due to viral gastroenteritis with rotavirus accounting for 40% of cases in children under five.[1](p. 17) In travelers however bacterial infections predominate.[6]
It can also be the part of the presentations of a number of medical conditions such as: Crohn's disease or mushroom poisoning.
There are many causes of infectious diarrhea, which include viruses, bacteria and parasites.[7] Norovirus is the most common cause of viral diarrhea in adults,[8] but rotavirus is the most common cause in children under five years old.[9] Adenovirus types 40 and 41,[10] and astroviruses cause a significant number of infections.[11]
The bacterium campylobacter is a common cause of bacterial diarrhea, but infections by salmonellae, shigellae and some strains of Escherichia coli (E.coli) are frequent.[12] In the elderly, particularly those who have been treated with antibiotics for unrelated infections, a toxin produced by Clostridium difficile often causes severe diarrhea.[13]
Parasites do not often cause diarrhea except for the protozoan Giardia, which can cause chronic infections if these are not diagnosed and treated with drugs such as metronidazole,[14] and Entamoeba histolytica.[15][16]
Other infectious agents such as parasites and bacterial toxins also occur.[17] In sanitary living conditions where there is ample food and a supply of clean water, an otherwise healthy person usually recovers from viral infections in a few days. However, for ill or malnourished individuals, diarrhea can lead to severe dehydration and can become life-threatening.[18]
Malabsorption is the inability to absorb food, mostly in the small bowel but also due to the pancreas.
Causes include celiac disease (intolerance to wheat, rye, and barley gluten, the protein of the grain), lactose intolerance (intolerance to milk sugar, common in non-Europeans), fructose malabsorption, pernicious anemia (impaired bowel function due to the inability to absorb vitamin B12), loss of pancreatic secretions (may be due to cystic fibrosis or pancreatitis), short bowel syndrome (surgically removed bowel), radiation fibrosis (usually following cancer treatment), and other drugs, including agents used in chemotherapy.
The two overlapping types here are of unknown origin:
Another possible cause of diarrhea is irritable bowel syndrome (IBS) which usually presents with abdominal discomfort relieved by defecation and unusual stool (diarrhea or constipation) for at least 3 days a week over the previous 3 months.[19] There is no direct treatment for IBS, however symptoms can be managed through a combination of dietary changes, soluble fiber supplements, and/or medications.
According to two researchers, Nesse and Williams, diarrhea may function as an evolved expulsion defense mechanism. As a result, if it is stopped, there might be a delay in recovery.[21] They cite in support of this argument research published in 1973 which found that treating Shigella with the anti-diarrhea drug (Lomotil) caused people to stay feverish twice as long as those not so treated. The researchers indeed themselves observed that: "Lomotil may be contraindicated in shigellosis. Diarrhea may represent a defense mechanism".[22]
The following types of diarrhea may indicate further investigation is needed:
A severity score is used to aid diagnosis in children.[23]
A rotavirus vaccine has the potential to decrease rates of diarrhea.[1]
In many cases of diarrhea, replacing lost fluid and salts is the only treatment needed. This is usually by mouth – oral rehydration therapy – or, in severe cases, intravenously.[1] Diet restrictions such as the BRAT diet are no longer recommended.[24] Research does not support the limiting of milk to children as doing so has no effect on duration of diarrhea.[25]
Medications such as loperamide (Imodium), bismuth subsalicylate may be beneficial, however they may be contraindicated in certain situations.[26]
While antibiotics are beneficial in certain type of acute diarrhea they are usually not used except in specific situations.[27][28] There are concerns that antibiotic may increase the risk of hemolytic uremic syndrome in people infected with Escherichia coli O157:H7.[29] In resource poor countries treatment with antibiotics may be beneficial.[28]
Anti motility agents like loperamide are effective at reducing the duration of diarrhea.[28]
While bismuth compounds (Pepto-Bismol) decreased the number of bowel movements in those with travelers' diarrhea it does not decrease the length of illness.[30] These agents should only be used if bloody diarrhea is not present.[31]
Probiotics are bacterial supplements that can help prevent recurrence of diarrhea. The most widely used probiotics include lactobacillus and saccharomyces boulardii. For those who suffer from lactose intolerance, taking digestive enzymes containing lactase when consuming dairy products is recommended.
World wide in 2004 approximately 2.5 billion cases of diarrhea occurred which results in 1.5 million deaths among children under the age of five.[1] Greater than half of these were in Africa and South Asia.[1] This is down from a death rate of 5 million per year two decades ago.[1] Diarrhea remains the second leading cause of death (16%) after pneumonia (17%) in this age group.[1]
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This article is a travel topic.
Food poisoning – and its main symptom diarrhea – is undoubtedly the most common traveller's illness. In many ways it's unavoidable: no matter how fanatical you are about food preparation, it's still liberally sprinkled with millions of airborne bacteria. At home, due to this constant exposure to the local germs, odds are very high that you're already immune to them. But in other parts of the world, where the bacteriological fauna are new to you, you're far more likely to run into problems. Thus the scourges of Delhi Belly, the Pharaoh's Curse, Montezuma's Revenge, and their many friends.
There's an old adage for eating in the Third World:
This seems simple, but in practice it's a tough road to follow, the problem being not so much the risk of accident as the risk of temptation. For example, the following items are highly likely to cause problems:
Test: It's another sweltering hot day in Delhi and that curry you just ate is still scorching your throat, so how about a nice strawberry shake to cool you down? If you said "Sure!", you may just have passed an intestinal death sentence on yourself: that shake contains every single one of the four high-risk items. The ice that makes it cold has either been made from tap water or, worse yet, comes from the factory in huge blocks that are often literally dragged down the street. Milk spoils very quickly in the tropics. And those yummy leafy veggies and unpeeled fruits have been washed in that same parasite-laden tap water... if at all.
Having read this, your instinctive reaction will be to panic and to head for the nearest expensive, air-conditioned tourist restaurant. Bad move. They're still using the same ingredients, stored with the same levels of hygiene or lack thereof, but because it's a tourist restaurant their business model relies on catching a couple of tourists a day, instead of feeding a crowd of locals. This, in turn, means that those same ingredients have, more probably than not, been sitting around a long time waiting for you.
What to do then? It's a numbers game, but here are a few guidelines to improve your odds of escaping unscathed:
The good news is that in a couple of days you'll start to acclimatize to the local bacteria and your odds of getting sick will start to decrease. The bad news is that it only takes one fly in the wrong place at the wrong time to foil all your precautions, and that if you stick around for a while, a run-in with food poisoning is, alas, more or less inevitable.
So one day your luck runs out, and you find yourself feeling distinctly queasy. Runny bowels or simple diarrhea don't really qualify for food poisoning, but if you...
...then, well, you're reading the right article. The first thing to do is to get the acute phase over with: head for the toilet, kneel in front of the bowl and let go. You won't start to feel better until you start throwing up, and you won't get this over with until your stomach is empty, so just do it. Do not attempt to eat anything, and do not drink anything other than water yet. When there's nothing left, wash your mouth, brush your teeth and go to bed. You'll feel more alive in the morning. If, however...
...you may have something worse and should see a doctor. Do not try to just fight it off.
Your main priority with any form of regular food poisoning has to be re-hydration. You're losing fluids constantly from any number of orifices, and your symptoms will become worse if you start to dry out. Feelings of thirst are the important early sign of dehydration, others are headache, difficulty with or inability to urinate, and falling blood pressure and associated signs (dizziness). Check the colour of your urine; the lower your body is on water, the darker it gets. Not urinating at all is also a warning sign that you're low on water.
In order to maintain hydration, drink lots and lots of water. If you are losing a great deal of water you also need to replace electrolytes. The medical rehydration recipe is:
You can get oral re-hydration solutions or sachets from a pharmacy but they are essentially the same as a flavoured version of the above.
"Saudi champagne", a 50-50 mixture of soda water and apple juice, is fairly palatable and reasonably close to the right mix for rehydration.
For mild cases of dehydration, weak tea (sweetened), flat soda, and some diluted fruit juices are all good (but avoid vitamin C). Drinking a glass or two an hour till everything stops running out the other end should stop you becoming too dehydrated. Aim for drinks at room temperature.
Do not drink caffeinated drinks or alcohol.
If you are vomiting intermittantly, you should drink in regular sips rather than one big glass or more of water. Start sipping about half an hour after each vomiting episode.
For the next few days, you will find that your appetite has all but disappeared. Don't force yourself to eat. If you feel like eating something, stick to bland, stomach-friendly foods like rice, porridge, crackers, bread. But be aware that food for you is also food for any bug that has made you sick, so take it slowly and stop if things get worse. Eat to match your appetite: Don't chuck down large quantities of food to make up for the last few days, instead eat small portions spread out over the day.
Avoid dairy products and oily food.
Some people find that — as a preventative or in treating mild cases — yoghurt helps. It is a bacterial culture; the hope is that the benign yoghurt bacteria will overwhelm the nasty ones. Do not try this if you are acutely ill; you will just heave up the yoghurt and feel even worse.
Do not, repeat, do not take any antidiarrheal or antiemetic drugs. These will just block up the nasty stuff in your system and you'll risk turning (relatively) harmless food poisoning into something much worse. A doctor may prescribe antibiotics in severe cases, but this is usually overkill. Don't take aspirin to calm things down — aspirin requires a healthy stomach.
If your travelling companions are down for the count, the best thing you can do for them is supply them with water and rehydration solution, and, alas, possibly clean up after them. Wash your hands with very warm water and soap after cleaning, touching the sufferer, handling their clothes or bedding, and of course before eating.
Some groups of people are very vulnerable to dehydration after developing diarrhea. In particular, because of their small bodies, toddlers and babies dehydrate extremely quickly; elderly people also dehydrate more quickly than young adults, and any illness is serious in someone immunocompromised (eg, by AIDS or chemotherapy). A baby with diarrhea should be taken to the doctor immediately if it is under 3 months old, and also if it is older and is either vomiting, has a fever or has stopped wetting its nappy regularly, as this means it is dehydrated.
Once sick with vomiting and/or diarrhea do not, if at all possible, prepare or handle food that other people intend to eat as you may infect them with your illness. Continue not to handle others' food for at least 2 days after the symptoms are gone. Sufferers should be extra vigilant about washing their hands thoroughly with warm water and soap before meals and after using (or cleaning) the toilet.
Avoid using the same toilet with an infected person if you can. Reserve and quarantine one toilet for the use of the infected person (it still has to be kept clean, though) and use another one for yourself (or make sure the others use it if you are the one who is sick). If this is not possible, you (or someone else) have to use the same toilet with someone sick, disinfecting the toilet with household bleach after each and any use (defecating, urinating, throwing up, you name what else) by the infected person is a wise precaution. Although not very environmentally friendly, household bleach is generally the cheapest and most common option available (it has different names in different countries (for example eau de Javel in French-speaking countries, after the name of the town which it was first produced), if you don’t know the local name, check the label, it will state that it contains “sodium hypochlorite” (substitute “natrium” for “sodium” in some of the Germanic-, and Slavic-speaking countries), sometimes with the percentage: up to 5%). Pour the bleach on every part of the toilet bowl that was possibly in contact with the bodily wastes after all the solid dirt is removed (solid material hinders disinfecting properties of bleach). Don’t flush bleach down immediately, let it sit for at least 5-10 minutes so it has enough time to kill the nasty bugs. An important thing to remember: Never mix or use bleach together with acid toilet cleaners which contain hydrochloric acid or sulphuric acid and are commonly found in parts of Asia, especially in Indian subcontinent. The chemical reaction causes the release of very dangerous chlorine gas which burns your lungs (in the best case) or kills you (in the worst case). As common sense requires, don’t let any of these strong chemicals come in touch with your skin and keep them away from children or other people who may mistake them as a drink.
Some food related illnesses can spread rapidly through groups of people particularly where the group is regularly gathering for meals. If you are travelling in a group of people (particularly in a closed environment like a cruise ship) or attending a conference or similar gathering it is good to inform the organisers or medical staff if any of your illness so that they are alert to a possible problem for everyone else.
Sometimes ordinary food poisoning turns into (or is) something worse. If you have reason to suspect any of these, see a doctor, as any of the following conditions require medical care.
Cholera is an extreme form of diarrhea caused by the Vibrio cholerae bacterium, identifiable by torrents of liquid stool with white flecks of mucus ("rice water stools"), up to 20 liters (20% of body weight) in a single day. The skin and lips may turns black and blue and eyes sink. If untreated, death can occur within 24 hours, but with proper hydration the fatality rate is under 1%. The disease is rare, but endemic to the Indian subcontinent and typically occurs in epidemics.
An injected vaccine has been available for some decades, but is not very effective. Recently several oral vaccines [1] have been developed. None are 100% effective against cholera either. Some also provide partial immunity against some other stomach infections.
Dysentery is an inflammation of the intestines resulting in severe diarrhea with blood or pus in the feces, often accompanied by fever or painful stomach cramps. Mostly found in the tropics and closely linked to poor hygiene, it remains a devastatingly lethal illness in much of the Third World, but can be easily treated with modern medicine. There are two major causes:
Dysentery can be confirmed by a stool test, but differentiating the bacillary and amoebic types takes at least 48 hours, so medication for both is often started simultaneously. The condition can usually be cured with five days of treatment with antibiotics (for bacillary) or metronidazole (for amoebic), and hospitalization is usually only necessary if fluid loss is extreme. The stool of dysentery patients can be highly contagious, so frequent handwashing for caregivers is essential.
Also known as stomach flu, this is a viral infection of the stomach tissue (gastritis) or the small bowel (enteritis) that causes stomach pain and frequent watery stools. The diseases is passed through contaminated water, including shellfish in that water, and typical causes include rotaviruses, noroviruses, adenoviruses, sapoviruses, and astroviruses. The main treatment is rehydration and most cases resolve on their own. Antibiotics do not work, but may be used in severe cases to prevent complications.
Also known as beaver fever, this can be identified by explosive diarrhea, foul-smelling flatulence and vomiting, often starting 1-2 weeks after infection and recurring in cycles. The cause is the Giardia lamblia protozoan, which is transmitted by the fecal-oral route, and often strikes people consuming untreated water in the wilderness and also in countries with poor hygiene. (It's endemic to the tap water systems of some places, like St. Petersburg in Russia.) Two-thirds of the people affected are silent carriers, and the condition often resolves itself with time. However, once identified, giardiasis can be cured a single dose of tinidazole. Metronidazole is a common alternative in poorer countries, and is often available from pharmacies.
Characterized by slow buildup, up to a week, to high fever (40°C) with heavy sweating and, in later stages, delirium. Diarrhea is green and bloodless; however, some patients have constipation instead. Caused by the Salmonella bacterium, identified by blood or stool test, and usually easily cured with antibiotics. Untreated cases have 10-30% fatality rates and may take up to a month to cure. Vaccination is available.
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Contents |
From Ancient Greek διάρροια (“‘through-flowing’”), from διά (dia), “‘through’”) + ῥέω (rheō), “‘flow’”).
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Singular |
Plural |
diarrhea (uncountable)
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Diarhhea is a common disease that can in severe cases lead to death. Be very careful when treating a child with diarrhea, and make sure you know how to classify the severity of each case, and how to treat it. Also learn the causes of diarrhea and teach parents how it is spread so they can take preventative measures.
Treatment Classification Causes
Diarrhea causes dehydration, which can be identified through various signs. Refer a child to a health center if he has either of the following two danger signs.
There are also some minor signs -- if the child has any two of the following minor signs, refer him to a health center:
Referral Testing Skin Turgidity
Pinch the skin on the child's stomach and time how long it takes to return to its normal position.
There are three principles of treatment for diarrhea:
First Principle / Liquids Second Principle / Nutrition Third Principle / Taking to Health Center
Keep the following in mind:
Please note! If the child has excessive diarrhea, it is important to keep feeding him ORS.
ORS Next Principle Treatment Overview
ORS or Oral Rehydration Solution, is essential in the treatment of diarrhea. You need to know how to prepare it, how much to give to a child, and how to feed it to the child.
ORS Preparation How much to give Feeding ORS
Note: If ORS solution is not available, take a glass of water and put one teaspoon of sugar and one fourth teaspoon and stir
After every stool:
Feed the child ORS with small sips from a cup, or by using a teaspoon. If the child vomits, wait ten minutes and then try again, but slower than before. Keep feeding the child ORS or additional liquids until the diarrhea has completely stopped.
During diarrhea, feed the child soft food appropriate for his age, such as khichri, sujhi ki kheer, mashed potatoes, mashed bananas, vegetables, seasonal fruit, etc.
Previous principle Next principle
Refer the child to a health center immediately if you see even one of the following danger signs:
Referral Previous Principle Treatment Overview
Diarrhea is caused by the following:
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The English used in this article or section may not be easy for everybody to understand. You can help Wikipedia by making this page or section simpler. |
Diarrhea (DIE-uh-REE-uh), also spelled diarrhoea, is feces that are runny or liquid. In a baby it is the most common symptom of malnutrition. This means not eating enough, or well enough.
There are many other diseases that cause it. Most are temporary and related to diet - the food you eat. Food safety and hand washing can lower the risk of getting diarrhea. Some causes other than disease are stress and drinking too much alcohol.
In developing nations, malnutrition is a common cause of child death. Diarrhea is often treated with aspirin or glucose - these reduce pain and may stop some symptoms for a while. However, if the root cause is malnutrition, it will not save the child's life. Spending money on rehydrating salts, clean water, and more food is wiser, as the first step.
The opposite of diarrhea, firm feces are a sign of good digestive health. Many people adopt vegetarian diets with high dietary fibre to prevent diarrhea and other digestive problems.
   | Rehydration Project - Diarrhoea, Diarrhea, Diarrea - What Is Diarrhoea and How to Prevent It - Rehydration Project |
| | Reducing deaths from diarrhoea through oral rehydration therapy. - Reducing deaths from diarrhoea through oral rehydr...[Bull World Health Organ. 2000] - PubMed Result |
 | Travelers' Diarrhea - Disease Listing, Travelers' Diarrhea, General Information | CDC Bacterial, Mycotic Diseases |
| | Diarrhea in nontravelers: risk and etiology - Chicago Journals - Clinical Infectious Diseases |
| | Use of a new phage preparation in prophylaxis and treatment of shigellosis. - Use of a new phage preparation in prophylaxis and ...[Acta Microbiol Acad Sci Hung. 1974] - PubMed Result |
| | Bacteriophage Therapy - Bacteriophage Therapy -- Sulakvelidze et al. 45 (3): 649 -- Antimicrobial Agents and Chemotherapy |
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